Instrument access device

ABSTRACT

An instrument access device  1  comprises a proximal member  25  for location externally of an opening into a body cavity. A first connector  20  extends between the proximal member  25  and a first instrument receiver  2 . A second connector  21  extends between the proximal member and a second instrument receiver  3 . Instrument seals can be housed in relatively rigid housings for added strength.

This application is a Continuation of U.S. patent application Ser. No.12/885,011, filed Sep. 17, 2010 now abandoned, which is aContinuation-In-Part of U.S. patent application Ser. No. 12/694,888,filed Jan. 27, 2010 now U.S. Pat. No. 8,657,740, which claims thebenefit of Provisional Application No. 61/147,625, filed Jan. 27, 2009,and Provisional Application No. 61/147,613 filed Jan. 27, 2009.

U.S. patent application Ser. No. 12/694,888 is also aContinuation-In-Part of U.S. patent application Ser. No. 12/133,827,filed Jun. 5, 2008 now U.S. Pat. No. 8,187,178, which claims the benefitof Provisional Application Nos. 60/924,918, filed Jun. 5, 2007;60/935,625 filed Aug. 22, 2007; and 60/996,760 filed Dec. 4, 2007.

U.S. patent application Ser. No. 12/885,011 also claims the benefit ofU.S. Provisional Application No. 61/243,295 filed on Sep. 17, 2009. Thecontent of all of the above applications is incorporated herein byreference.

INTRODUCTION

The invention relates to an instrument insertion device and aninstrument access system incorporating the instrument insertion device.

STATEMENTS OF INVENTION

According to the invention there is provided an instrument access devicecomprising: —

-   -   a proximal member for location externally of an opening into a        body cavity;    -   a first instrument receiver for receiving an instrument; and    -   a second instrument receiver for receiving an instrument.

In one embodiment the device comprises a first connector extendingbetween the proximal member and the first instrument receiver. There maybe a second connector extending between the proximal member and thefirst instrument receiver.

In one embodiment at least one of the connectors is substantially rigid.

In one case a joint between at least one of the connectors and theproximal member which facilitates movement of the connector relative tothe proximal member.

The joint may facilitate pivotal or swivelling movement of theconnector.

In one case the joint is substantially a universal joint.

In one embodiment the device comprises a formation between the connectorand the proximal member to facilitate relative movement between theconnector and the proximal member. The formation may comprise a groove.

In another embodiment the device comprises a spacer for location betweenthe proximal member and the outside of a wound opening. The spacer maybe flexible. The spacer may be of flexible material. The spacer maycomprise a pad which may comprise foam, rubber, or the like.

In one aspect of the invention there is provided an instrument accessdevice comprising a proximal member for location externally of anopening into a body cavity, a first instrument receiver for receiving aninstrument, a second instrument receiver for receiving an instrument, aproximal mounting for location outside of a wound opening, the proximalmember being releasably mounted to the proximal mounting and a flexiblespacer for location between the proximal mounting and the outside of awound opening.

In one embodiment at least one of the connectors comprises an instrumentseal.

In another embodiment the device comprises a flexible cannula extendingfrom at least one of the connectors. The flexible cannula may beattached to the connector.

The cannula may be movable relative to the connector. For example, thecannula may be slidable relative to the connector.

In another embodiment the device comprises a third instrument receiverfor receiving an instrument and a third connector extending between theproximal member and the first instrument receiver.

In a further embodiment the device comprises a port such as an openingin the proximal member which is sized to receive a small instrument or atube. The opening may be a diameter of from 1 to 5 mm, typically from 2to 4 mm.

In one case the opening has a valve means. There may be a cap for theopening.

In another embodiment at least one of the connectors has an associatedseal or valve. The seal may comprise a first valve and a second valvedistal of the first valve.

In one case the first valve comprises a lip-seal valve.

The second valve may comprise at least two cusps such as a duckbillvalve.

In one case the lipseal is provided in a lipseal housing and the secondvalve is provided in a second seal housing. The lipseal housing may bemovable relative to the second seal housing. The lip seal housing maycomprise a cap for the second seal housing. In one case the lipsealhousing is removable from the second seal housing. The lipseal housingmay be releasably connected to the second seal housing. The lipsealhousing may be connected to the second seal housing by a hingeconnection such as a strap. The lipseal housing may comprise a reducercap.

In one embodiment the device comprises a distal anchoring member forlocation within a wound interior; and a retractor member extendingproximally from the distal anchoring member to retract laterally thesides of a wound opening.

The retractor member may extend at least between the distal anchoringmember and the proximal member. The retractor member may extend in twolayers between the distal anchoring member and the proximal member.

In one case a first end portion of the retractor member is fixed to theproximal member.

The retractor member may be movable relative to the distal anchoringmember. A second end portion of the retractor member may be movablerelative to the proximal member.

In one embodiment the retractor member extends distally from theproximal member to the distal anchoring member, is looped around thedistal anchoring member, and extends proximally from the distalanchoring member to the proximal member.

The proximal member may comprise an inner part and an outer part. Theretractor member may extend between the inner part and the outer part.

In one embodiment the device comprises a mounting member for mounting tothe proximal member. The mounting member may be releasably mounted tothe proximal member. The mounting member may be mounted to the proximalmember in an interference fit arrangement. The mounting member may bemounted to the proximal member in a snap-fit arrangement.

In one case the device comprises a clamp to clamp the mounting member tothe proximal member.

It will be appreciated that features described with reference to oneembodiment of the invention may be utilised with any of the otherembodiments.

BRIEF DESCRIPTION OF THE DRAWINGS

The invention will be more clearly understood from the followingdescription of some embodiments thereof, given by way of example only,with reference to the accompanying drawings, in which: —

FIG. 1 is an isometric view of an instrument access device according toone embodiment of the invention;

FIG. 2 is a cross sectional view of the device of FIG. 1, in use;

FIG. 3 is an isometric view of an instrument access device according toanother embodiment of the invention;

FIG. 4 is a cross sectional view of the device of FIG. 3, in use;

FIG. 5 is an isometric view of another instrument access device of theinvention;

FIG. 6 is a cross sectional view of the device of FIG. 5, in use;

FIG. 7 is an isometric view of part of an instrument access device ofthe invention;

FIGS. 8a and 8b are cross sectional views of part of the deviceaccording to one embodiment in different configurations of use;

FIGS. 9a and 9b are cross sectional views of part of the deviceaccording to another embodiment in different configurations of use;

FIGS. 10a and 10b are cross sectional views of part of the deviceaccording to a further embodiment in different configuration of use;

FIG. 11 is an isometric view of another instrument access device of theinvention;

FIG. 12 is a cross sectional view of the device of FIG. 11, in use;

FIG. 13 is an isometric view of another instrument access deviceaccording to the invention;

FIGS. 14 to 18 are cross sectional views illustrating some of thedevices of the invention, in use;

FIGS. 19 and 20 are isometric views of another instrument access deviceof the invention;

FIGS. 21 and 22 are views of the device of FIGS. 19 and 20 in differentuses;

FIGS. 23 and 24 are isometric views of a valve assembly of an instrumentaccess device;

FIG. 25 is an exploded isometric view of one valve assembly;

FIG. 26 is a cross sectional view of part of the valve assembly of FIG.25;

FIG. 27 is an exploded isometric view of another valve assembly;

FIG. 28 is a cross sectional view of part of the valve assembly of FIG.27;

FIG. 29 is an exploded isometric view of a further valve assembly;

FIG. 30 is a cross sectional view of part of the valve assembly of FIG.29;

FIG. 31 is an exploded perspective view of another instrument accessdevice according to the invention;

FIG. 32 is a perspective view of the device of FIG. 31 assembled;

FIG. 33 is a top plan view of the device of FIG. 32;

FIG. 34 is an elevational view from one side of the device of FIG. 32;

FIG. 35 is an elevational view from another side of the device of FIG.32;

FIGS. 36 and 37 are exploded perspective views of a further instrumentaccess device according to the invention;

FIG. 38 is a top plan view of the device of FIGS. 36 and 37;

FIGS. 39 and 40 are elevational views from opposite sides of theassembled device of FIGS. 36 to 38;

FIG. 41 is an exploded perspective view of another instrument accessdevice according to the invention;

FIG. 42 is a perspective view of the device of FIG. 41 assembled;

FIG. 43 is a top plan view of the device of FIG. 42;

FIGS. 44 and 45 are elevational views from opposite sides of the deviceof FIG. 42;

FIG. 46 is an isometric cut-away view of portion of the device of FIGS.41 to 45;

FIG. 47 is a top plan view of the device of FIG. 46; and

FIG. 48 is a cross sectional view on the line A-A in FIG. 47.

DETAILED DESCRIPTION

Referring to the drawings and initially to FIGS. 1 and 2 there isillustrated an instrument access device 1 according to the inventionwhich in this case comprises three instrument insertion sealing devicesaccording to the invention. The access device 1 comprises a firstinstrument insertion device 2, a second instrument insertion device 3,and a third instrument insertion device 4. The access device in thiscase also has two insufflation/desufflation ports 6, 7.

The insertion device 2 comprises a lipseal 10 through which aninstrument 11 is insertable and a second seal member 12 having apassageway extending therethrough, through which the instrument 11 isinsertable. The first insertion device 2 also has a reducer cap 15 whichhas a further lipseal 16 which is smaller than the lipseal 10. To insertlarge diameter instruments, the cap 15 is removed. To insert smallerdiameter instruments the cap 15 is in place.

Referring to FIGS. 27 and 28 the second seal member 12 may comprise aduckbill valve through which the instrument 11 passes. The duckbillvalve 12 provides sealing engagement with the instrument shaft whilstaccommodating lateral movement of the instrument as illustrated.

Alternatively, as illustrated in FIGS. 25 and 26 the second valve maycomprise a multicusp valve such as a tricuspid valve 50. In another caseas illustrated in FIGS. 29 and 30 the second valve may comprise a foamor gel.

The lipseal valve 10 is located proximally of the duckbill valve 12 sothat a double seal is provided to substantially prevent leakage ofinsufflation gas.

The lipseal 10 may be of any suitable material. For example it may be ofan elastomeric material, a foam-type material or a gelatinous material.The duckbill valve 12 may be of any suitable material. For example, itmay be of a flexible polymeric material.

The second and third instrument insertion devices 3, 4 may be of thesame or different construction as that of the first instrument insertiondevice 2.

The instrument access device of the invention is suitable for use duringlaparoscopic surgery to facilitate instrument access to an insufflatedabdominal cavity while maintaining pneumoperitoneum.

The instrument access device of the invention comprises a firstconnector 20 for connecting the first instrument insertion device 2 to aconnector base 25, a second connector 21 for connecting the secondinstrument insertion device 3 to the base 25, and a third connector 22for connecting the third instrument insertion device 4 to the base 25.

The base 25 is mounted to a proximal ring assembly 26 of a retractorwhich includes a sleeve 27 which may extend in two layers between adistal anchoring ring (not shown) and the proximal ring assembly 26. Onesuch retractor is described in our US 2005-0090717A, the entire contentsof which are incorporated herein by reference. The base 25 has a tab 29to aid dismounting of the base member 25 from the retractor. A pull ring30 may be used to aid release of the retractor.

The instrument insertion devices 2, 3, 4 are arranged in sealingrelationship to a body of a patient, in use. The instrument seals 2, 3,4 are spaced proximally of the proximal ring assembly 26.

The connectors 20, 21, 22 connect the proximal ring assembly 26 to theinstrument seals 2, 3, 4. The connectors 20, 21, 22 may be integral withthe connector base 25 and the seals 2, 3, 4 subsequently attached, forease of manufacture. In addition, instrument seals 2, 3, 4 can be housedin relatively rigid housings for added strength whilst maintainingconnector flexibility.

In use, a wound opening is created in a tissue wall, and the distalanchoring ring is inserted through the wound opening into the woundinterior. The proximal ring assembly 26 is located externally of thewound opening, with the retractor member extending proximally from thedistal anchoring member through the wound opening. The second end of theretractor member is pulled proximally relative to the proximal ringassembly 26 to retract laterally the sides of the wound opening.Instruments may then be inserted through the instrument seals 2, 3, 4,extended through the connectors 20, 21, 22, and extended through theretracted wound opening and into the wound interior.

Referring especially to FIGS. 1 to 6 in this case the connectors 20, 21,22 are of a substantially rigid material to aid stability as instrumentsare inserted and withdrawn.

In the embodiment of FIGS. 1 and 2 the valve assemblies 2, 3, 4 arefixed to their connectors 20, 21, 22 and at least some of the connectorshave internal extended flexible cannulae 60, 61 which can be manipulatedfor ease of positioning of an instrument. One of the connectors may havea more rigid cannula 62 to guide some types of instruments.

In the case of the devices of FIGS. 1 and 2 one or more of the cannulae60, 61, 62 may be fixed at the proximal end. Alternatively, asillustrated in FIGS. 3 and 4 one or more and in the case illustrated allof the cannulae 60, 61, 62 are slidably movable relative to theconnectors 20, 21, 22.

Referring now to FIGS. 5 and 6 in this case cannulae 70, 71, 72 extendfrom the connectors 20, 21, 22 and the proximal seals are provided atthe proximal ends of the cannulae 70, 71, 72. One or more of thecannulae 70, 71, 72 may be at least partially flexible. Indeed some orall of the cannulae may be rigid.

Referring especially to FIGS. 7 to 12 a joint between at least one andin this case all of the connectors 20, 21, 22 and the proximal member 25facilitates movement of the connector(s) relative to the member 25.Referring to FIGS. 7 and 8 in one case the joint comprises a groove 80or area of reduced thickness to accommodate pivotal or swivellingmovement. The arrangement may have an integral bias to return theconnector to one position (FIGS. 7, 8(a)). FIGS. 10(a) and 10(b)illustrate a joint 85 which is similar to that of FIGS. 8(a) and 8(b).Alternatively, the joint may comprise a flexible extension leg 87 tofacilitate flexible movement.

Referring to FIGS. 11 and 12 in this case there is a ball and sockettype joint 90 between the connector and the proximal member 25 tofacilitate movement in many directions.

Referring to FIGS. 13 to 15 in one case there is a spacer 100, forexample comprising a pad of flexible material such as foam or rubberwhich is interposed between the proximal ring assembly 26 and the bodyoutside the wound opening. The pad 100 is sufficiently flexible to allowswivelling or pivotal movement of the device in situ to provide even agreater freedom of movement. In addition, because the proximal ringassembly 26 is spaced away from the body the retractor sleeve 27 can bemore easily manipulated and does not become trapped at the proximal end.The pad 100 may also assist in reducing trauma and bruising duringsurgery.

FIGS. 18 and 19 illustrate the use of the tab 29 in demounting theinstrument access device from the retractor base, the base 25 beingdetached from the proximal ring assembly 26.

Referring now to FIGS. 19 to 22 there is illustrated another instrumentaccess device which in this case has a port or hole 110 to facilitateinsertion of a small instrument 111 or tube 112. The port 110 hasclosure cap 113. In this case the port 110 is provided in the proximalmember 25. The port has a relatively small diameter, typically 3 to 5 mmand can be used to allow escape of smoke which may be generated duringthe procedure such as a cauterisation procedure. The tube 112 may have aluer connector 115 at the proximal end which may be attached to avacuum/suction source. The tube may also be used for blood removaland/or irrigation/cleaning. The port 110 can also be used fordesufflation and/or insufflation.

Referring to FIGS. 31 to 35 there is illustrated another instrumentaccess device 200 according to the invention which is similar to thedevices described above and like parts are assigned the same referencenumerals. In this case the access device comprises a first instrumentinsertion device 201, a second instrument insertion device 202, a thirdinstrument insertion device 203, and a fourth instrument insertiondevice 204. The first instrument insertion device 201 can accommodate aninstrument of up to 10 mm diameter and has a reducer cap 15 which, whenclosed, converts the insertion device to accommodate an instrument of upto 5 mm diameter. The second, third and fourth instrument insertiondevices 202, 203, 204 can all accommodate instruments of up to 5 mmdiameter.

The device 200 of FIGS. 31 to 35 is particularly suitable for use in amethod of performing a laproscopic surgical procedure as described inour US2009/0036745A, the entire contents of which are incorporatedherein by reference. The three instrument insertion devices 202, 203,204 extend in a direction towards a surgeon performing the procedure.The pull tab 29 can be used as a reference in this aspect, pointing awayfrom the surgeon. The arrangement of the insertion devices isergonomically efficient as the surgeon can readily manipulate tissueretraction and camera instruments inserted through the devices 202, 203,204. The larger device 204 points away from the surgeon as it may beused only occasionally during the procedure, for example in removingdissected tissue. In this way the available space is optimised. Oneexample of a procedure using the device of FIGS. 31 to 35 is acholecystectomy.

Referring to FIGS. 36 to 40 there is illustrated another instrumentaccess device 250 according to the invention which is similar to thedevices described above and like parts are assigned the same referencenumerals. In this case the access device comprises first, second andthird instrument insertion devices 251, 252, 253 respectively. The firstinstrument insertion device 251 can accommodate an instrument of up to10 mm diameter and has a reducer cap 15 which, when closed, can convertto accommodate an instrument of up to 5 mm diameter. The second andthird instrument insertion devices 252, 253 can all accommodateinstruments of up to 5 mm diameter.

The device 250 of FIGS. 36 to 40 is particularly suitable for use insurgical procedures which require the use of larger diameter instrumentssuch as a morcellator (which is used for example in gynecologicalprocedures such as uterus removal), or instruments for tissue specimenremoval, gastric banding, endocath bag delivery (which are used forlarger organs such as a kidney. Larger organs/tissue specimens can beremoved by detaching the access device from the retractor base.

In the case of the access devices of FIGS. 31 to 40 an incision oftypically 10 to 25 mm in length is made. The devices allow procedures tobe carried out laparoscopically which would not otherwise be possiblethrough such a small incision.

Referring to FIGS. 41 to 45 there is illustrated another instrumentaccess device 300 according to the invention which is similar to thedevices described above and like parts are assigned the same referencenumerals. In this case the access device comprises first, second, third,fourth and fifth instrument insertion devices 301, 302, 303, 304, 305respectively. The first instrument insertion device 301 can accommodateinstruments of up to 10 mm diameter. The device 301 has a reducer cap 15which, when closed, can convert to accommodate an instrument of up to 5mm diameter. The second instrument insertion device 302 can accommodateinstruments of up to 15 mm diameter. The device 302 has a reducer cap 15which, when closed, can convert to accommodate an instrument of up to 5mm diameter. The third instrument insertion device 303 can accommodateinstruments of up to 12 mm diameter. The device 303 has a reducer cap 15which, when closed, can convert to accommodate an instrument of up to 5mm diameter. The fourth and fifth instrument insertion devices 304, 305can accommodate instruments of up to 5 mm diameter.

The device 300 of FIGS. 41 to 48 is particularly suitable for use incomplex procedures which require multiple instruments. One suchprocedure is Nissen fundiplication which is a surgical procedure used totreat gastroesophageal reflux disease (GERD). In the case of the deviceof FIGS. 41 to 48 an incision of typically 20 to 60 mm in length ismade. The device allows complex procedures to be carried outlaproscopically which would not otherwise be possible.

A base part of the access device of FIGS. 41 to 45 is illustrated inFIGS. 46 to 48. The valves/seals have been omitted in these drawings.The connector or receiver leg parts of the instrument insertion devices301, 302, 303, 304, 305 are assigned the reference numerals 311, 312,313, 314, 315 respectively. Access holes 316, 317 for theinsufflation/desufflation ports 6, 7 are also illustrated. The base partis of a relatively flexible material and in this case is reinforced by areinforcing ring 320 of a more rigid material. The reinforcing ring 320is embedded in the base using overmoulding.

The instrument insertion devices may be coded such as by indicia orcolour coding to indicate a particular instrument size that may be usedwith a particular device size. For example, the colour blue may be usedto indicate use with an instrument of up to 5 mm in size, white for upto 10 mm instruments, grey for up to 12 mm instruments, and orange forup to 15 mm instruments.

It will be appreciated that features described with reference to oneembodiment of the invention may be utilised with any of the otherembodiments.

The invention is not limited to the embodiments hereinbefore describedwhich may be varied in detail.

The invention claimed is:
 1. An instrument access device, comprising: awound retractor, including: a longitudinal axis, a proximal ring-shapedmember for location externally of a wound opening, a distal ring-shapedmember for location within a wound interior, the distal ring-shapedmember defining a central opening extending therethrough, a sleeveextending at least from the distal ring-shaped member to the proximalring-shaped member; and a seal assembly including a plurality ofinstrument seals and a plurality of cannulae, wherein: each of theinstrument seals is located proximal to the proximal ring-shaped member,each of the instrument seals is movable with respect to the proximalring-shaped member, and each of the cannulae is coupled to one of theinstrument seals and extends distally from the one of the instrumentseals into the wound retractor, each of the cannulae is freely movablethroughout the central opening of the distal ring-shaped member, and atleast one cannula is configured to bend to have a curved configurationand extends distal to the distal ring-shaped member of the woundretractor.
 2. The instrument access device of claim 1, wherein theplurality of seals includes three instrument seals, the three instrumentseals being bisected by a longitudinally-extending plane through theseal assembly.
 3. The instrument access device of claim 1, wherein twoinstrument seals are substantially equally-spaced from alongitudinally-extending plane.
 4. An instrument access device,comprising: a wound retractor, including: a longitudinal axis, aproximal ring-shaped member for location externally of a wound opening,a distal ring-shaped member for location within a wound interior, asleeve extending at least from the distal ring-shaped member to theproximal ring-shaped member, and a central passage extending through theproximal ring-shaped member, the distal ring-shaped member, and thesleeve; and a seal assembly including a plurality of instrument seals, aplurality of connectors, and a plurality of cannulae, wherein: each ofthe instrument seals is located proximal the proximal ring-shapedmember, each of the instrument seals is movable with respect to theproximal ring-shaped member, each of the instrument seals includes alongitudinal axis, with distances between longitudinal axes of theinstrument seals increasing in a direction extending proximally from aproximal side of the proximal ring-shaped member, each of the instrumentseals is supported by one of the connectors, and each of the cannulaeextends through one of the connectors and the central passage, with atleast one connector and at least one cannula being configured to flexbetween straight and bent configurations.
 5. The instrument accessdevice of claim 4, wherein the longitudinal axes of the instrument sealsare each angled relative to the longitudinal axis of the woundretractor.
 6. The instrument access device of claim 4, wherein theplurality of instrument seals includes three instrument seals,longitudinal axes of the three of the instrument seals beingsubstantially coplanar.
 7. The instrument access device of claim 4,wherein each of the instrument seals is coupled to one of the connectorsand to one of the cannulae.
 8. An instrument access device, comprising:a wound retractor, including: a longitudinal axis, a proximalring-shaped portion for location externally of a wound opening, a distalring-shaped portion for location within a wound interior, and aretraction sleeve extending at least proximally from the distalring-shaped portion to the proximal ring-shaped portion; and a sealassembly, including: at least one instrument seal spaced proximal to theproximal ring-shaped portion and laterally movable with respect to theproximal ring-shaped portion, a base member, at least one tubular sealconnector having a distal end at the base member, the at least onetubular seal connector connecting the at least one instrument seal tothe base member, and at least one cannula, a proximal end of the atleast one cannula being coupled to a distal end of the at least oneinstrument seal, the at least one cannula extending through the at leastone tubular seal connector and distal to the distal end of the at leastone tubular seal connector and the base member, the at least one cannulahaving a passage configured to receive an instrument inserted throughthe at least one instrument seal.
 9. The instrument access device ofclaim 8, wherein the at least one instrument seal includes a pluralityof instrument seals, the at least one tubular seal connector includes aplurality of tubular seal connectors, and the at least one cannulaincludes a plurality of cannulae.
 10. The instrument access device ofclaim 9, wherein each of the instrument seals is spaced proximal to theproximal ring-shaped portion by one of the tubular seal connectors. 11.The instrument access device of claim 8, wherein the at least onecannula is slidable relative to the at least one tubular seal connector.12. The instrument access device of claim 8, further including a spacermember coupled to a distal surface of the proximal ring-shaped portion.13. The instrument access device of claim 12, wherein the spacer memberincludes a pad made of foam or rubber.
 14. The instrument access deviceof claim 8, wherein the at least one tubular seal is coupled to theproximal ring-shaped portion by the base member.
 15. The instrumentaccess device of claim 14, wherein the seal assembly further includes aport configured to provide fluid communication between proximal anddistal sides of the base member.
 16. The instrument access device ofclaim 15, wherein the seal assembly further includes a closure capconfigured to close the port.
 17. The instrument access device of claim8, wherein the proximal end of the at least one cannula is receivedwithin the at least one tubular seal connector.